Comparative efficacies of vitamin D supplementation regimens in infants: a systematic review and network meta-analysis

• Published in: British journal of nutrition 2024-08, Vol.132 (4), p.440-452
• Main Authors: Abiramalatha, Thangaraj, Ramaswamy, Viraraghavan Vadakkencherry, Thanigainathan, Sivam, Yadav, Bharti, Bandyopadhyay, Tapas, Shaik, Nasreen Banu, Devi, Usha, Pullattayil, Abdul Kareem, Sasidharan, Rohit, Gupta, Neeraj
• Format: Article
• Language: English
• Subjects: 25-Hydroxyvitamin D; Babies; Bayesian analysis; Breastfeeding & lactation; Calciferol; Clinical trials; Data analysis; Dietary supplements; Dosage; Effectiveness; Human and Clinical Nutrition; Hypercalcemia; Hypervitaminosis; Infants; Intervention; Meta-analysis; Monte Carlo simulation; Neonates; Nutrition; Pediatrics; Performance evaluation; Professional associations; Prophylaxis; Rickets; Software; Systematic review; Systematic Review and Meta-Analysis; Vitamin D; Vitamin deficiency
• ISSN: 0007-1145; 1475-2662; 1475-2662
• DOI: 10.1017/S0007114524001685

Vitamin D deficiency in infants is widely prevalent. Most paediatric professional associations recommend routine vitamin D prophylaxis for infants. However, the optimal dose and duration of supplementation are still debated. We aimed to compare the efficacy and safety of different vitamin D supplementation regimens in term and late preterm neonates. For this systematic review and network meta-analysis, we searched MEDLINE, the Cochrane Central Register of Controlled Trials and Embase. Randomised and quasi-randomised clinical trials that evaluated any enteral vitamin D supplementation regimen initiated within 6 weeks of life were included. Two researchers independently extracted data on study characteristics and outcomes and assessed quality of included studies. A network meta-analysis with a Bayesian random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. Primary outcomes were mean serum vitamin D concentrations and the proportion of infants with vitamin D insufficiency (VDI). We included twenty-nine trials that evaluated fourteen different regimens of vitamin D supplementation. While all dosage regimens of ≥400 IU/d increased the mean 25(OH)D levels compared with no treatment, supplementation of ≤250 IU/d and 1400 IU/week did not. The CoE varied from very low to high. Low CoE indicated that 1600 IU/d, compared with lower dosages, reduced the proportion of infants with VDI. However, our results indicated that any dosage of ≥800 IU/d increased the risk of hypervitaminosis D and hypercalcaemia. Data on major clinical outcomes were sparse. Vitamin D supplementation of 400–600 IU/d may be the most effective and safest in infants.